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Bargaining Down the Medical Bills

Only a very small portion of consumers or insurers pay 100 percent of our hospital charges, said Ruth Levin, an executive with Continuum Health Partners, a nonprofit hospital system.Credit
Ozier Muhammad/The New York Times

WHEN money is tight, everything is negotiable — including your health care bills.

As the economy sheds jobs and more people lose their health insurance or are forced to switch to less generous plans, doctors and hospitals are becoming accustomed to patients who are struggling financially. According to the American Hospital Association, half of their members reported an increase in the number of patients needing help with their bills. And that was in November, before the national unemployment rate hit 8.1 percent.

“It’s rough out there,” said Dr. Jacques Moritz, the director of gynecology at St. Luke’s-Roosevelt Hospital Center in New York, who also has a private practice in Manhattan. (Full disclosure: He delivered my son five years ago, but my insurance at the time covered me in full.)

Lately, Dr. Moritz said, “The first thing I say to my long-term patients is, ‘Do you still have a job?’ ” If patients say no, or otherwise indicate that paying will not be easy, Dr. Moritz says he assures them that bills are negotiable.

And keep in mind that doctors, hospitals and medical labs are accustomed to negotiating. After all, they do it all the time with insurers. A hospital may have a dozen or more rates for one procedure, depending on whether Medicare, Medicaid or a private insurer is paying the bill, said Ruth Levin, corporate senior vice president for managed care of Continuum Health Partners, a nonprofit hospital system in New York. Your request for a special arrangement will hardly confound their accounting department.

DON’T BE SHY “Patients are often intimidated by their doctors — it’s the white coat,” said Dr. Davis Liu, a family doctor in California and author of “Stay Healthy, Live Longer, Spend Wisely” (Stetho Publishing, 2008). “But if you need help, speak up. Most are likely to help out.”

Talk directly to your doctor about your financial situation. If that makes you uncomfortable, then go to the billing manager. The office may be able to offer you a discount of 10 to 30 percent depending on the practice (specialists may offer a bigger break), or propose a plan in which you pay your balance in a few installments or on a monthly basis — typically at no interest.

OFFER TO PAY CASH UPFRONT Doctors can lose thousands of dollars every year on unpaid bills and spend countless hours haggling with insurers over reimbursements. If you can make their life simpler by offering to pay right away, you’re likely to get a small discount — even if you don’t have financial hardship.

BE RESPECTFUL You’re negotiating for your health, not haggling over a used car. So Dr. Moritz cautions you not to call your physician and say: “Dr. So-and-So will do the procedure for $300 less. Can you match that?”

“When someone does that,” Dr. Moritz says, “that’s the end of the relationship.”

Talking to Hospitals

STRIKE A DEAL, THEN CHECK IN If you need shoulder surgery, for instance, but don’t have insurance — or are facing a high hospital co-payment — call the hospital’s billing department and explain that you would like to discuss getting a discount and why. Dr. Moritz suggests saying, “I’d like to pay the lowest rate you give an insurance company.”

If you end up with a bill you can’t pay — or at least can’t pay right away — don’t panic. Find out what Medicare would pay for your condition or surgery, since that program tends to pay less than private insurers. You can learn that at the federal Department of Health and Human Services database, www.hospitalcompare.hhs.gov, by clicking on the gray button “find and compare hospitals.”

I learned on the Web site, for example, that if I were admitted to my local hospital for chest pain, the average Medicare payment would be $5,732. Use the Medicare numbers as the starting point for your negotiation.

The truth is, said Ms. Levin of Continuum Health Partners, “only a very small portion of consumers or insurers pay 100 percent of our hospital charges.”

If your situation is truly dire or your bill very large, you may qualify for charity care. But you’ll have to show the hospital proof of your income and your hardship.

Bargaining With Labs

Charges for lab work can be exorbitant. But, as with hospital bills, the numbers you see on your statement may not reflect what most insurers actually pay, according to Dr. Woodson C. Merrell, chairman of the department of integrative medicine at Beth Israel Medical Center in New York.

Negotiate just as you would with your doctor or hospital. Quest Diagnostics, the largest clinical laboratory in the country, for instance, offers a six-month interest-free payment plan, as well as financial assistance for those with real hardship.